Chen YK, Chen YC, Lin WX, Zheng JH, Liu YY, Zou J, Cai JH, Ji ZQ, Chen LZ, Li ZY, Chen YX. Follicular carcinoma of the thyroid with a single metastatic lesion in the lumbar spine: A case report. World J Clin Cases 2022; 10(26): 9493-9501 [PMID: 36159419 DOI: 10.12998/wjcc.v10.i26.9493]
Corresponding Author of This Article
Ye-Xi Chen, MD, Chief Doctor, Professor, Department of Thyroid, Breast and Hernia Surgery, The Second Affiliated Hospital of Shantou University Medical College, No. 69 North Dongxia Road, Shantou 515000, Guangdong Province, China. yxchen3@stu.edu.cn
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Yao-Kun Chen, Wei-Xun Lin, Jie-Hua Zheng, Yi-Yuan Liu, Juan Zou, Jie-Hui Cai, Ze-Qi Ji, Ling-Zhi Chen, Zhi-Yang Li, Ye-Xi Chen, Department of Thyroid, Breast and Hernia Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou 515000, Guangdong Province, China
Yu-Chun Chen, Department of Bone, Joint and Spine Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou 515000, Guangdong Province, China
Author contributions: All authors contributed to the study conception and design; Chen YX and Li ZY performed the literature concept; Chen YK and Chen YC wrote the original draft and resources; Lin WX and Zheng JH reviewed and edited the manuscript; Liu YY, Zou J, Cai JH, Ji ZQ and Chen LZ investigated and collected these cases; All authors have read and approved the final manuscript; Chen YK and Chen YC contributed equally to this work.
Supported bythe Medical Scientific Research Foundation of Guangdong Province, China, No. A2021432 and B2021448; the Shantou Medical Science and Technology Planning Project, No. 210521236491457 and 210625106490696; and the Undergraduate Innovation Training Project of Shantou University, No. 31/38/47/54.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors have no relevant financial or non-financial interests to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ye-Xi Chen, MD, Chief Doctor, Professor, Department of Thyroid, Breast and Hernia Surgery, The Second Affiliated Hospital of Shantou University Medical College, No. 69 North Dongxia Road, Shantou 515000, Guangdong Province, China. yxchen3@stu.edu.cn
Received: May 12, 2022 Peer-review started: May 12, 2022 First decision: June 8, 2022 Revised: June 17, 2022 Accepted: August 11, 2022 Article in press: August 11, 2022 Published online: September 16, 2022 Processing time: 112 Days and 17.2 Hours
Abstract
BACKGROUND
The bone is the second most common site of thyroid cancer metastasis, after the lung. Treatment options for bone metastasis of thyroid cancer include surgery, radioiodine therapy (RAIT), external radiation therapy, thyroid-stimulating hormone (TSH) inhibition, bisphosphonates, and small-molecule targeted therapies. In most cases, thyroid carcinoma is found in the thyroid tissue; reports of follicular thyroid carcinoma with a single metastasis to the lumbar spine are rare.
CASE SUMMARY
We report a case of bone metastasis as the only clinical manifestation of thyroid cancer. The patient was a 67-year-old woman with lumbar pain for 7 years and aggravation with intermittent claudication who had previously undergone partial thyroidectomy of a benign thyroid lesion. No abnormal nodules were found in the bilateral thyroid glands. However, imaging studies were consistent with a spinal tumor, and the lesion was diagnosed as a metastatic follicular carcinoma of thyroid origin. We adopted a multidisciplinary collaboration and comprehensive treatment approach. The patient underwent lumbar spine surgery, total resection of the thyroid, postoperative TSH suppression therapy, and RAIT. There were no complications associated with the operation, and the patient had good postoperative recovery. She has experienced no recurrence.
CONCLUSION
Follicular thyroid carcinoma is associated with early hematogenous metastasis, and the bone is a typical site of metastasis. Single bone metastasis is not a contraindication to medical procedures, and providing the appropriate therapy can result in better outcomes and quality of life for these patients.
Core Tip: Although bone metastasis from differentiated thyroid cancer is common, it is very rare for bone metastasis to be the solitary presentation of thyroid cancer. Here, we present a case of bone metastasis of follicular thyroid carcinoma with no indication of primary cancer. The patient had undergone partial thyroidectomy 20 years previously for thyroid nodules, but the pathological diagnosis at that time was a benign thyroid lesion. We employed a multi-institution, multidisciplinary team to diagnose and treat this patient, and she has had a good outcome thus far. This case highlights several important issues, such as the importance of follow-up for patients with seemingly indolent lesions and the utility of a comprehensive treatment approach.
